West Africa’s Contraceptive Revolution: 5 Lessons for the International Community

Publication Date: 05/02/2019

The Ouagadougou Partnership has been a unique experience. I have spent the last six years serving as Director of the Coordination Unit of the Ouagadougou Partnership — a collaboration between nine francophone countries in West Africa and numerous international donors and local implementing partners. The Partnership was launched in 2011 as a vehicle to better coordinate common goals and funding for family planning in the region and to address the fact that a higher percentage of women die in childbirth and pregnancy in Francophone West Africa than anywhere else in the world. And if it has worked in Francophone West Africa, why can’t a similar partnership work in other parts of the world?

Over the past six years, I have witnessed the ingenuity, partnership, and hard work that allowed three million additional women to use modern contraception, which is more than during the previous 21 years. We are now seeing an unprecedented mobilization of Francophone West African youth in the family planning movement — young people are taking up the cause for themselves. Rural and urban communities, religious and traditional leaders, and Ministries of Health are working arm-in-arm towards a shared vision: A Francophone West Africa in which all women and girls can use modern contraception if they want it.

“…to propel our progress beyond 2020, we have mapped exactly where lack of information, services, and rights are hampering our populations, almost to the household level.”

So, how have we done it? Put simply, the Ouagadougou Partnership was created to unify countries having similar backgrounds and social norms and to develop a shared vision and common goal. By holding themselves and donors accountable to that goal, a healthy competition among member countries has emerged. Specifically, I think there are three elements that have led to our unprecedented progress in family planning in Francophone West Africa: First, all nine member countries in the Partnership developed costed implementation plans (CIP) for family planning that have served as roadmaps — keeping countries grounded in tangible, practical goals and actions. Second, the Partnership creates shared incentives for all stakeholders — enabling the exchange of ideas, data, and technical resources among members to allow greater, quicker, and more sustainable gains; these advances, in turn, have helped keep interest and commitment in the Partnership strong. And third, the Coordination Unit provides efficient management, keeping all activities on schedule and the collaboration moving forward.

But the Partnership’s success barely scratches the surface of what still needs to be done — and it is pushing us to think beyond 2020. We cannot rest on our laurels. We know what to do, how to do it, and where to do it. For example, high-impact practices exist to rapidly improve reproductive health and rights in the region and these interventions have been successfully piloted and scaled in many contexts. To propel our progress beyond 2020, we have mapped exactly where lack of information, services, and rights are hampering our populations, almost to the household level.

“…While we still need to innovate, we have solid evidence that this type of model works well.”

As I prepare to pass the baton to my successor after I retire from the Coordination Unit (although I will never retire fully from the work itself!), I want to share five priorities for the international community that will maintain momentum, preserve this successful model, and keep the contraceptive revolution moving forward. The family planning community must:

Embrace multi-sectoriality: Family planning is not only a health issue; it weaves through society in a myriad of ways and affects outcomes across health, education, finance, social services, and many other sectors crucial to future societal and individual success. By embracing family planning, Francophone West Africa is demonstrating to the next generation that we are listening to them and that we honor them. We show them we are working towards a demographic dividend that will offer vital societal resources to them as they grow and mature.

Link Family Planning with other global agendas: As family planning affects more than just the health of individuals and society, we need to link family planning to other global agendas, such as climate change, immigration, women’s empowerment, and human rights. These movements share goals with family planning initiatives, as well as a willingness to coordinate their investments and be mutually accountable in meeting country commitments. We need to imagine scenarios where linked agendas lead to positive impacts across the board.

Address financial equity: Establishing a financing mechanism similar to the Global Fund or Gavi could help close the funding gap for family planning in countries that have fewer resources. We’ve seen this model work — and work well — on those health issues, and now with the Global Financing Facility, an increasing number of Partnership countries are eligible for additional funding for RMNCAH-N. We hope to see this translate into increases in funding for family planning. The availability of this type of mechanism for additional funding should mean advances in the uptake of family planning, without program directors having to spend too much time with fundraising.

Use scientific evidence to guide interventions: We don’t just need evidence-based solutions to help bring modern contraceptive methods and education to more women and girls in Francophone West Africa: we need these solutions tailored to the specific needs, wishes, and context of the population served. These solutions may vary greatly from country to country, and even from village to village. They need to be well-designed and forward-thinking solutions that employ solid social science principles, relevant data about the people and how they make decisions, and a great deal of listening before they are implemented.

Help countries build political will: We cannot only help countries see the benefits of really investing in family planning, but we can help them make those investments more sustainable through win-win partnerships between countries and donors. Programs such as equitable matching funds to support implementation of countries’ CIPs will help countries invest more and build the political will to sustain such investments.

We have accomplished so much, and there is so much to be proud of. But it will never be enough as long as women and girls are still dying because they did not or could not access vital family planning services. This is not impossible — the Ouagadougou Partnership has already accomplished achievements beyond what people thought possible. And why shouldn’t similar regional initiatives work in other parts of the world? Let’s keep our eyes on our common vision and rely on our model of proven success and strength in partnership. While we still need to innovate, we have solid evidence that this type of model works well. Let’s share our Francophone West African experience with other parts of the world and keep working to ensures everyone has access to family planning.